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THE SCOTCH UNIVERSITIES COMMISSION: WHY SHOULD DEGREES IN ARTS NOT BE MORE ACCESSIBLE TO MEDICAL STUDENTS?
1084
out-patient department of the infirmary is as follows :- it out, and the remedy for these is in the hands of the board Every patient on coming to the infirmary is closely of management of the infirmary. In conclusion, I wish to express my indebtedness to the questioned by the hospital clerk as to his or her weekly wage. If the applicant for relief is in receipt of a higher general superintendent of the infirmary, Mr. W. L. Saunder, wage than the one stated below, he or she is invited to for much valuable information in connexion with this contribute a small sum towards the hospital. If they are subject. I am, Sirs, yours faithfully, considered to be able to pay a private medical practitioner, THOMAS HARRIS, M.D. the fact is brought to the knowledge of the assistant Mosley-street, Manchester, Nov. 18th, 1889. physician or assistant surgeon for the day, and, unless he deems them to be urgently in need of medical attention, they are refused relief. All other applicants are THE SCOTCH UNIVERSITIES COMMISSION: WHY SHOULD DEGREES IN ARTS NOT admitted; but patients living in Manchester or Salford are almost immediately visited by an officer of the ManBE MORE ACCESSIBLE TO MEDICAL chester and Salford District Provident Society, who makes STUDENTS? inquiries into their position, and is authorised to act as To the Editors of THE LANCET. is in receipt of a wage follows. If12s.any single manoror awoman married couple of a wage SIRS,-Many matters, no doubt, will occupy the attention exceeding per week, exceeding 18s. per week (Is. 6d. extra being allowed for each of the University Commissioners, and, having to consider child), the oiiicer withdraws their infirmary card, and the universities as a whole, they no doubt will deal with informs them that they are not admissible to, and many matters connected with the separate faculties in a, He different manner than if they were dealing solely with one can no longer receive treatment at, the infirmary. advises them to join the provident dispensary of the faculty, such as Law or Medicine. There is one subject, district in which they reside, and gives them all neces- which, though not strictly medical, is of such importance Before a new to medical men that it should certainly meet with the sary particulars for becoming members. member of the Society, however, is entitled to benetit, a most careful consideration from the Commissioners. Th& period of a month must elapse; and in the interval, under importance of this matter alone warrants the occupation of the pages of THE LANCET with this article. It is to be hoped an arrangement made with the infirmary authorities, he is wild permitted, on producing evidence of having joined the that the medical professors of the Scotch universities is at a distinct make common cause to what to to receive advice and attend and remedy present provident dispensary, medicine at the infirmary without making any payment. hardship to the student of medicine. I allude to the subjects Further, if, after joining the provident dispensary, the dis- required and the time taken up in attaining the degree of pensary medical officer considers the case more suitable for M.A. The time may be practically stated as four winter treatment at the infirmary, the person may continue at sessions of six months each, the subjects are laid down on the hospital without payment, If such a provident patient hard-and-fast lines, and little or no change has been made is admitted as an in-patient to the infirmary, no charge is in the course within the memory of man. To graduate made, although all other in-patients are invited to con- in Arts and Medicine in Scotland really means eight yearn, of study. It is a great pity that the arrangements of all tribute towards the expenses. The results of this system in the hospitals which have the universities as regards their Arts degree were not re adopted it is partly told by Dr. Rentoul in his letter to modelled, made more elastic, and more in accordance with THE LANCET of the 16th inst. During the first year (1875) the requirements ot the age we live in. In the Dublin of the application of the system, it was found that 42’32 University the medical student receives certain exemptions per cent. of the patients attending those hospitals were in in the course for B.A., and at least two subjects that enter into his medical course can be taken in the Arts course. a position either to join the provident dispensary or to Without taking up time by critically examining into and employ a private medical attendant; in the following year the number had fallen to 24’5 per cent., and the fall has stating particularly the advantages offered by the more been almost continuous ever since. Last year it was found elastic mode in which an Arts degree can be attained in that the number of cases which were unsuitable for treat- Oxford and Cambridge, I may just roughly state that ment at those hospitals was as low as 6’53 per cent. (at the botany, chemistry, and zoology can be taken at Cambridge in the Arts course, and such classes count in the Medical Royal Infirmary it was only 6 per cent.).). As regards the effectiveness of this system in checking course; while in Oxford any student who has graduated as abuse, I can speak very positively. Unlike the hospital B.A., and has been placed in the first or second class in the physicians to whom Dr. Rentoul refers, I am keenly School of Natural Science, and received from the public interested in the question of hospital reform, and no one is examiner a special certificate of his attainments in mechanical philosophy, chemistry, botany, or biology, need not be more anxious than I am to prevent the abuse of our hospitals, examined again for his M. B. degree in any science specified in an abuse which is not only demoralising to the patient, but detrimental to the interests of the hospitals and to all such certificate. Now, if we turn our eye to the Scotch univerbranches of the medical profession. For some time past I sities, we find that the course for the M.A. really extends have closely watched for instances of abuse on the medical over four winter sessions, and necessitates attendance on side of the infirmary out-patient department (I wish it to classes of Latin, Greek, mathematics, logic, moral philobe clearly understood that I am only able to testify as to sophy, natural philosophy, and English literature. By that branch of the infirmary work), but I have not found passing an entrance examination on certain subjects it is a single undoubted instance of a person coming whom I possible to get the degree in three winter sessions of six considered ought not to do so, and who resided within months each; very few, however, seem able to get thethe area of the Manchester and Salford District Provident degree in less than the usual four winter sessions. As in Society. The only cases where there has been any apparent the Universities of Oxford, Cambridge, and Dublin, a B.A. abuse, and such instances have not been numerous, have degree once existed in some of the Scotch universities, but been patients whose statements could not be verified, it it was done away with at some date-about 1860. This being found impossible to inquire into the circumstances is much to be regretted, and it is now almost imperative of patients living in districts outside Manchester and that the Scotch universities should make an Arts degree of a more comprehensive character than it is at present. obviously widely scattered. If I mightbe allowed to offer any criticisms on the details In all universities such a degree as a pass B.A. should be a; of this system, I should say that the wage limit is decidedly certificate of the training and knowledge necessary for a, too low. I would make the wage limit about 15s. for a man to take his place in educated society, and it should single person, and about 21s. for a married couple, allowing, furnish reliable evidence of his fitness for a learned prosay, 2s. extra for each child. Another apparent fault in the fession. It would be very convenient if a degree in Arts, details of the system is that it is more fair to the provident were given in the universities with a complement of a dispensary than to the infirmary. A provident dispensary certain number of subjects as a total for the degree, but patient may not only be referred to the infirmary for out- with a certain number of such subjects optional, so that the patient treatment by the dispensary medical man, but if divine, the lawyer, and the doctor of medicine of the future admitted as an in-patient he obtains advice and medicine might, with a common groundwork, choose the number of free, no officer of the infirmary being allowed to ask such a subjects-when choice was allowed-that might suit their patient to contribute to the hospital funds. It will be seen, future career. Any subject which again entered into a. however, that these faults, if faults they can be considered, degree examination in the different faculties should havea, are not due to the general system, but to details in carrying certain test value and standard, and should exempt from
1085 other degree examinations in such subjects. It would be unnecessarv to have a college residence of more than two winters and two summers-the winter term six months, the summer term three months,-provided the examination could be passed. Having to spend four years in the acquisition of an Arts degree is what prevents its being taken, as it should be, by the bulk of M.B.’s. The following rudimentary sketch will give an idea of what I should propose, and what I believe would meet with great acceptance, be useful to all the professions, increase the numbers of Arts graduates, and cancel the slur of want of general academic culture which hangs over the bulk of the medical profession. I would here point out the value of This a knowledge of French and German to medical men. has not so far received proper attention. The elementary education of medical men has so far been conducted too much on old lines. At one time Latin was the language of the learned of all nations, and, as such, a thorough knowledge of it was a necessity in foreign travel, in publication of researches, discoveries, and records, or, in short, for any work done in any branch of learning. It was an absolute necessity that such should be written in the Latin tongue, so as to be accessible to all interested in such subjects. A knowledge of Latin, the language of erudition, enabled the student, the divine, the lawyer, or the doctor to travel and to sojourn at seats of learning with comfort and profit, to give and receive knowledge, and to exchange opinions on topics of professional, scientific, or literary interest. Nowadays this is greatly changed, and in France, Germany, Switzerland, Austria, Italy, and Russia a knowledge of French is really, of all languages other than English, the most useful.
Sketch Plan ,for Compulsory to all. Latin Greek Mathematics Natural Philosophy
In the recent past, and even in the present, Latin and Greek have absorbed too much of the attention both of schoolmaster and scholar, to the exclusion of English, French, and German. A certain amount of Latin and Greek may be granted as necessary, but to devote several years almost exclusively to the study of the dead languages is altogether too much to require from those who intend to devote themselves to a profession where the best brain efforts are necessary to acquire a knowledge of the work which has been done even in one or two of its departments, not to speak of adding to that knowledge by original research. It is on these grounds that I would strongly press for some alteration in the present academic curriculum which eventuates in a degree in Arts. By all means make the Honour degrees high-make them severe tests of scholarship in the dead languages, more especially as qualifications for fellowships, where such exist ; but at the same time reconsider and readapt the ordinary course of study for the requirements of the age; institute new chairs (notably of German and French) so as to enable such a course to be carried out. Institute an entrance examination in English, geography, arithmetic, the history of England, Scotland, Ireland, and France, and in Latin and Greek, then necessitate a two winter and summers’ residence at a university and an attendance on at least four classes compulsory to all, and four classes to be selected as suitable to students of the different faculties, granting the B.A. degree on passing an examination on such subjects and exempting in future degrees from examination in such subjects, the tests being as high as in special degree examinations. a
B.A.
Degree. For B.L.
Suitable for B.D. ....
....
....
....
Moral Philosophy English Literature .... ....
Hebrew French or German .... ....
History English Literature French German
For M.B. ....
....
....
or
Medical
Jurisprudence ....
Botany
Natural
History Chemistry
French
or
German
At present the Arts professors in the Scotch universities reststudents, especially medical students. University profrom their labours for half each year. Why should they not fessorial life insensibly tends to strong conservatism. Such have a three-months’ summer course like their medical an opportunity as now presents itself for remodelling the colleagues? From many points of view a summer term in Arts degree, making it more accessible and more useful to Arts would be convenient for students, especially for the the different professions, must be my excuse for touching future student of Medicine. on this subject. Arts professors may probably look on the course and the I am, Sirs, yours faithfully, J. A. CAMPBELL, M.D., F.R.S.E. degree from a point of view different from that taken byI Carlisle.
REPORT OF THE COMMISSIONERS OF PRISONS. To the Editors of THE LANCET. SIRS,-The writer of the article on the Report of the Commissioners of Prisons, in your last issue, has fallen into error with regard to the number of prisoners who were found to be insane on admission into prison. The total ’number of inmates of the local prisons of England and Wales who were found to be insane during the year ended March 31st, 1889, was 349. Of these as many as 290 were recognised as being insane on admission into prison. I state in my " notes" that 93 " sentenced prisoners were found to be insane upon reception, and I give a table showing the number of insane prisoners received with Your sentences varying from three days to five years. reviewer takes this number (93) as being the number of prisoners found insane upon reception, and, deducting it ’from the total of 349, arrives at the conclusion that in 256 cases the insane condition was not detected by the prison medical officer upon admission. I should, perhaps, point out that many of the inmates of prisons are not undergoing ’sentences, but are under remand, or are awaiting trial.
be equally well, or perhaps better, treated in the prison infirmary under the care of medical officers, who are well accustomed to such cases; and you intimate that, though Dr. Gover’s suggestion would undoubtedly lead to a diminution in the prison death-rate, such a result should not be considered to the benefit of the unfortunate prisoners. I cannot think that the writer of your editorial remarks can have given sufficient attention to the report of the Commissioners of Prisons, for he has entirely missed the humanitarian argument conveyed in Dr. Gover’s remarks. Take the principal cases, mentioned in the report, of death soon after admission into prison. One, a of seventy-nine years, with a sentence of woman seven days, very infirm and exhausted on reception, who died on the sixth day. Another, a man of sixty-five years, with a sentence of seven days, suffering from advanced heart disease, died a few minutes after admission. Another, a
of thirty-five years, with a sentence of seven days, admitted dying of bronchitis, and who died on the following day. Another, a man of fifty-one years, with a sentence of six months, admitted ill with enlarged liver, died of syncope on the third day. Had these four unfortunate prisoners been examined by police surgeons none of them would have been suspected of malingering, nor would they have been I am, Sirs, your obedient servant, sent to prison. If we think for one moment, no such cruelty R. M. GOVER. Home Office, Whitehall, S.W., Nov. 18th. should have happened. Because the law demands punishment for offences, does it pay no attention to a dying manor woman? To the Editors of THE LANCET. Are such to be sent a journey, of perhaps ten to thirty miles, SIRS,—In your reference to Dr. Gover’s statement "that to die in a prison before even a week has expired ? From my it not infrequently happens that persons who are in an experience as surgeon of Canterbury Prison, I am convinced advanced state of disease and even dying are sent to prison," that magistrates should more often take the advice of the you make an objection to the inspector of prisons’ sugges- police surgeon when a prisoner’s body or mind is affected, tion that such cases ought rather to be taken to the nearest without considering the trouble of further investigation or hospital or to the workhouse infirmary than sent to prison. the question of expense. I would gladly see an institution You say that such a course would probably lead to a con- which would take up a position between a prison and a siderable amount of malingering ; that such cases can lunatic asylum, and would separately treat criminal imbeman
out-patient department of the infirmary is as follows :- it out, and the remedy for these is in the hands of the board Every patient on coming to the infirmary is closely of management of the infirmary. In conclusion, I wish to express my indebtedness to the questioned by the hospital clerk as to his or her weekly wage. If the applicant for relief is in receipt of a higher general superintendent of the infirmary, Mr. W. L. Saunder, wage than the one stated below, he or she is invited to for much valuable information in connexion with this contribute a small sum towards the hospital. If they are subject. I am, Sirs, yours faithfully, considered to be able to pay a private medical practitioner, THOMAS HARRIS, M.D. the fact is brought to the knowledge of the assistant Mosley-street, Manchester, Nov. 18th, 1889. physician or assistant surgeon for the day, and, unless he deems them to be urgently in need of medical attention, they are refused relief. All other applicants are THE SCOTCH UNIVERSITIES COMMISSION: WHY SHOULD DEGREES IN ARTS NOT admitted; but patients living in Manchester or Salford are almost immediately visited by an officer of the ManBE MORE ACCESSIBLE TO MEDICAL chester and Salford District Provident Society, who makes STUDENTS? inquiries into their position, and is authorised to act as To the Editors of THE LANCET. is in receipt of a wage follows. If12s.any single manoror awoman married couple of a wage SIRS,-Many matters, no doubt, will occupy the attention exceeding per week, exceeding 18s. per week (Is. 6d. extra being allowed for each of the University Commissioners, and, having to consider child), the oiiicer withdraws their infirmary card, and the universities as a whole, they no doubt will deal with informs them that they are not admissible to, and many matters connected with the separate faculties in a, He different manner than if they were dealing solely with one can no longer receive treatment at, the infirmary. advises them to join the provident dispensary of the faculty, such as Law or Medicine. There is one subject, district in which they reside, and gives them all neces- which, though not strictly medical, is of such importance Before a new to medical men that it should certainly meet with the sary particulars for becoming members. member of the Society, however, is entitled to benetit, a most careful consideration from the Commissioners. Th& period of a month must elapse; and in the interval, under importance of this matter alone warrants the occupation of the pages of THE LANCET with this article. It is to be hoped an arrangement made with the infirmary authorities, he is wild permitted, on producing evidence of having joined the that the medical professors of the Scotch universities is at a distinct make common cause to what to to receive advice and attend and remedy present provident dispensary, medicine at the infirmary without making any payment. hardship to the student of medicine. I allude to the subjects Further, if, after joining the provident dispensary, the dis- required and the time taken up in attaining the degree of pensary medical officer considers the case more suitable for M.A. The time may be practically stated as four winter treatment at the infirmary, the person may continue at sessions of six months each, the subjects are laid down on the hospital without payment, If such a provident patient hard-and-fast lines, and little or no change has been made is admitted as an in-patient to the infirmary, no charge is in the course within the memory of man. To graduate made, although all other in-patients are invited to con- in Arts and Medicine in Scotland really means eight yearn, of study. It is a great pity that the arrangements of all tribute towards the expenses. The results of this system in the hospitals which have the universities as regards their Arts degree were not re adopted it is partly told by Dr. Rentoul in his letter to modelled, made more elastic, and more in accordance with THE LANCET of the 16th inst. During the first year (1875) the requirements ot the age we live in. In the Dublin of the application of the system, it was found that 42’32 University the medical student receives certain exemptions per cent. of the patients attending those hospitals were in in the course for B.A., and at least two subjects that enter into his medical course can be taken in the Arts course. a position either to join the provident dispensary or to Without taking up time by critically examining into and employ a private medical attendant; in the following year the number had fallen to 24’5 per cent., and the fall has stating particularly the advantages offered by the more been almost continuous ever since. Last year it was found elastic mode in which an Arts degree can be attained in that the number of cases which were unsuitable for treat- Oxford and Cambridge, I may just roughly state that ment at those hospitals was as low as 6’53 per cent. (at the botany, chemistry, and zoology can be taken at Cambridge in the Arts course, and such classes count in the Medical Royal Infirmary it was only 6 per cent.).). As regards the effectiveness of this system in checking course; while in Oxford any student who has graduated as abuse, I can speak very positively. Unlike the hospital B.A., and has been placed in the first or second class in the physicians to whom Dr. Rentoul refers, I am keenly School of Natural Science, and received from the public interested in the question of hospital reform, and no one is examiner a special certificate of his attainments in mechanical philosophy, chemistry, botany, or biology, need not be more anxious than I am to prevent the abuse of our hospitals, examined again for his M. B. degree in any science specified in an abuse which is not only demoralising to the patient, but detrimental to the interests of the hospitals and to all such certificate. Now, if we turn our eye to the Scotch univerbranches of the medical profession. For some time past I sities, we find that the course for the M.A. really extends have closely watched for instances of abuse on the medical over four winter sessions, and necessitates attendance on side of the infirmary out-patient department (I wish it to classes of Latin, Greek, mathematics, logic, moral philobe clearly understood that I am only able to testify as to sophy, natural philosophy, and English literature. By that branch of the infirmary work), but I have not found passing an entrance examination on certain subjects it is a single undoubted instance of a person coming whom I possible to get the degree in three winter sessions of six considered ought not to do so, and who resided within months each; very few, however, seem able to get thethe area of the Manchester and Salford District Provident degree in less than the usual four winter sessions. As in Society. The only cases where there has been any apparent the Universities of Oxford, Cambridge, and Dublin, a B.A. abuse, and such instances have not been numerous, have degree once existed in some of the Scotch universities, but been patients whose statements could not be verified, it it was done away with at some date-about 1860. This being found impossible to inquire into the circumstances is much to be regretted, and it is now almost imperative of patients living in districts outside Manchester and that the Scotch universities should make an Arts degree of a more comprehensive character than it is at present. obviously widely scattered. If I mightbe allowed to offer any criticisms on the details In all universities such a degree as a pass B.A. should be a; of this system, I should say that the wage limit is decidedly certificate of the training and knowledge necessary for a, too low. I would make the wage limit about 15s. for a man to take his place in educated society, and it should single person, and about 21s. for a married couple, allowing, furnish reliable evidence of his fitness for a learned prosay, 2s. extra for each child. Another apparent fault in the fession. It would be very convenient if a degree in Arts, details of the system is that it is more fair to the provident were given in the universities with a complement of a dispensary than to the infirmary. A provident dispensary certain number of subjects as a total for the degree, but patient may not only be referred to the infirmary for out- with a certain number of such subjects optional, so that the patient treatment by the dispensary medical man, but if divine, the lawyer, and the doctor of medicine of the future admitted as an in-patient he obtains advice and medicine might, with a common groundwork, choose the number of free, no officer of the infirmary being allowed to ask such a subjects-when choice was allowed-that might suit their patient to contribute to the hospital funds. It will be seen, future career. Any subject which again entered into a. however, that these faults, if faults they can be considered, degree examination in the different faculties should havea, are not due to the general system, but to details in carrying certain test value and standard, and should exempt from
1085 other degree examinations in such subjects. It would be unnecessarv to have a college residence of more than two winters and two summers-the winter term six months, the summer term three months,-provided the examination could be passed. Having to spend four years in the acquisition of an Arts degree is what prevents its being taken, as it should be, by the bulk of M.B.’s. The following rudimentary sketch will give an idea of what I should propose, and what I believe would meet with great acceptance, be useful to all the professions, increase the numbers of Arts graduates, and cancel the slur of want of general academic culture which hangs over the bulk of the medical profession. I would here point out the value of This a knowledge of French and German to medical men. has not so far received proper attention. The elementary education of medical men has so far been conducted too much on old lines. At one time Latin was the language of the learned of all nations, and, as such, a thorough knowledge of it was a necessity in foreign travel, in publication of researches, discoveries, and records, or, in short, for any work done in any branch of learning. It was an absolute necessity that such should be written in the Latin tongue, so as to be accessible to all interested in such subjects. A knowledge of Latin, the language of erudition, enabled the student, the divine, the lawyer, or the doctor to travel and to sojourn at seats of learning with comfort and profit, to give and receive knowledge, and to exchange opinions on topics of professional, scientific, or literary interest. Nowadays this is greatly changed, and in France, Germany, Switzerland, Austria, Italy, and Russia a knowledge of French is really, of all languages other than English, the most useful.
Sketch Plan ,for Compulsory to all. Latin Greek Mathematics Natural Philosophy
In the recent past, and even in the present, Latin and Greek have absorbed too much of the attention both of schoolmaster and scholar, to the exclusion of English, French, and German. A certain amount of Latin and Greek may be granted as necessary, but to devote several years almost exclusively to the study of the dead languages is altogether too much to require from those who intend to devote themselves to a profession where the best brain efforts are necessary to acquire a knowledge of the work which has been done even in one or two of its departments, not to speak of adding to that knowledge by original research. It is on these grounds that I would strongly press for some alteration in the present academic curriculum which eventuates in a degree in Arts. By all means make the Honour degrees high-make them severe tests of scholarship in the dead languages, more especially as qualifications for fellowships, where such exist ; but at the same time reconsider and readapt the ordinary course of study for the requirements of the age; institute new chairs (notably of German and French) so as to enable such a course to be carried out. Institute an entrance examination in English, geography, arithmetic, the history of England, Scotland, Ireland, and France, and in Latin and Greek, then necessitate a two winter and summers’ residence at a university and an attendance on at least four classes compulsory to all, and four classes to be selected as suitable to students of the different faculties, granting the B.A. degree on passing an examination on such subjects and exempting in future degrees from examination in such subjects, the tests being as high as in special degree examinations. a
B.A.
Degree. For B.L.
Suitable for B.D. ....
....
....
....
Moral Philosophy English Literature .... ....
Hebrew French or German .... ....
History English Literature French German
For M.B. ....
....
....
or
Medical
Jurisprudence ....
Botany
Natural
History Chemistry
French
or
German
At present the Arts professors in the Scotch universities reststudents, especially medical students. University profrom their labours for half each year. Why should they not fessorial life insensibly tends to strong conservatism. Such have a three-months’ summer course like their medical an opportunity as now presents itself for remodelling the colleagues? From many points of view a summer term in Arts degree, making it more accessible and more useful to Arts would be convenient for students, especially for the the different professions, must be my excuse for touching future student of Medicine. on this subject. Arts professors may probably look on the course and the I am, Sirs, yours faithfully, J. A. CAMPBELL, M.D., F.R.S.E. degree from a point of view different from that taken byI Carlisle.
REPORT OF THE COMMISSIONERS OF PRISONS. To the Editors of THE LANCET. SIRS,-The writer of the article on the Report of the Commissioners of Prisons, in your last issue, has fallen into error with regard to the number of prisoners who were found to be insane on admission into prison. The total ’number of inmates of the local prisons of England and Wales who were found to be insane during the year ended March 31st, 1889, was 349. Of these as many as 290 were recognised as being insane on admission into prison. I state in my " notes" that 93 " sentenced prisoners were found to be insane upon reception, and I give a table showing the number of insane prisoners received with Your sentences varying from three days to five years. reviewer takes this number (93) as being the number of prisoners found insane upon reception, and, deducting it ’from the total of 349, arrives at the conclusion that in 256 cases the insane condition was not detected by the prison medical officer upon admission. I should, perhaps, point out that many of the inmates of prisons are not undergoing ’sentences, but are under remand, or are awaiting trial.
be equally well, or perhaps better, treated in the prison infirmary under the care of medical officers, who are well accustomed to such cases; and you intimate that, though Dr. Gover’s suggestion would undoubtedly lead to a diminution in the prison death-rate, such a result should not be considered to the benefit of the unfortunate prisoners. I cannot think that the writer of your editorial remarks can have given sufficient attention to the report of the Commissioners of Prisons, for he has entirely missed the humanitarian argument conveyed in Dr. Gover’s remarks. Take the principal cases, mentioned in the report, of death soon after admission into prison. One, a of seventy-nine years, with a sentence of woman seven days, very infirm and exhausted on reception, who died on the sixth day. Another, a man of sixty-five years, with a sentence of seven days, suffering from advanced heart disease, died a few minutes after admission. Another, a
of thirty-five years, with a sentence of seven days, admitted dying of bronchitis, and who died on the following day. Another, a man of fifty-one years, with a sentence of six months, admitted ill with enlarged liver, died of syncope on the third day. Had these four unfortunate prisoners been examined by police surgeons none of them would have been suspected of malingering, nor would they have been I am, Sirs, your obedient servant, sent to prison. If we think for one moment, no such cruelty R. M. GOVER. Home Office, Whitehall, S.W., Nov. 18th. should have happened. Because the law demands punishment for offences, does it pay no attention to a dying manor woman? To the Editors of THE LANCET. Are such to be sent a journey, of perhaps ten to thirty miles, SIRS,—In your reference to Dr. Gover’s statement "that to die in a prison before even a week has expired ? From my it not infrequently happens that persons who are in an experience as surgeon of Canterbury Prison, I am convinced advanced state of disease and even dying are sent to prison," that magistrates should more often take the advice of the you make an objection to the inspector of prisons’ sugges- police surgeon when a prisoner’s body or mind is affected, tion that such cases ought rather to be taken to the nearest without considering the trouble of further investigation or hospital or to the workhouse infirmary than sent to prison. the question of expense. I would gladly see an institution You say that such a course would probably lead to a con- which would take up a position between a prison and a siderable amount of malingering ; that such cases can lunatic asylum, and would separately treat criminal imbeman